How Does ADHD Relate to Sleep Disorder?

Studies have shown that individuals with ADHD symptoms are more susceptible to the effects of sleep deprivation (and therefore sleep disorders like OSA).  ADHD (attention deficit hyperactivity disorder) is categorized by inattention, emotional instability, impulsiveness, and hyperactivity. The symptoms do vary from person to person, which is why researchers continue to investigate the different cognitive impairments associated with ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders in childhood and adulthood. It affects approximately 3%–5% of youth and 2.9% of adults.  If untreated, individuals with ADHD struggle with impairments across many areas of functioning, including academic, occupational, and social tasks.

Some people exhibit minor symptoms of ADHD but can still function on a daily basis without it affecting sleep patterns.  Others, however, display symptoms that become so overwhelming, that the individual can no longer perform the activities of daily life.

common ADHD symptoms

The most common sleep disturbances associated with ADHD are:

  1. Difficulty Falling Asleep
    • Approximately ¾ of adults have difficulty “shutting down” every night to fall asleep.  They get a burst of energy when they should be prepping to go to sleep.  Some get misdiagnosed with a mood disorder when it is really just mental restlessness.
    • 10-15% of children under the age of 12 have trouble falling asleep.  From the ages of 12-30, this number increases to 50%.  From that point forward, more than 70% of adults report that they spend 1+ hours trying to fall asleep.
  2. Restless Sleep
    • When sleep finally occurs, it consists of tossing and turning.  As seen in people with OSA and other sleep disorders, their sleep is not refreshing and therefore they awaken tired and remain fatigued throughout the day.
  3. Difficulty Waking Up
    • This typically consists of setting multiple alarms in the morning, but not being able to get out of bed.  Sometimes other family members or roommates try to wake them up, but the ADHD sufferer is usually combative and irritable.  They are not “morning people” as we would say.
    • One method of altering this consists of the individual setting one alarm one hour before they actually need to be awake, taking their prescribed medication (stimulant), and then one hour later, the medication starts working and allows them to get out of bed and start the day.  
ADHA and sleep disorders in children

Younger people are getting much less sleep than they did just ten years ago.  This is partly a result of the “addiction” to technological devices and an excess of screen time.  This was not an issue years ago, but has increasingly gotten worse over the last decade.

Although sleep problems are very common in individuals with ADHD, comorbid sleep disorders are often overlooked and left untreated in ADHD populations.

contributing factors in sleep difficulties in ADHD

Comorbidities and associations of ADHD are as follows:

  1. SDB (Sleep-disordered breathing)
    • Abnormal patterns of respiration and/or ventilation during sleep.  SDB affects stress/inflammation in the brain, emotional and cognitive responses, and repeated arousal-based sleep disruptions.
  2. RLS (Restless Leg Syndrome)
    • Sensorimotor disorder characterized by an urge to move the legs.  This often is accompanied by pain and muscle cramps in the legs, both during and after sleep.  The urge to move the legs are relieved temporarily by the movement, but can lead to insomnia, and then fatigue and restlessness the following day. Daytime symptoms of RLS may mimic ADHD.
  3. CRSD (Circadian Rhythm Sleep Disorder)
    • This involves a problem in the timing when a person sleeps and is awake. They are caused by alterations of the circadian time-keeping system.
    • The lack of an accurate circadian clock may also account for the difficulty that many with ADHD have in judging the passage of time. Their internal clocks are not “set.”
  4. DSPS (Delayed Sleep Phase Syndrome)
    • Occurs when a person regularly goes to sleep and wakes up >2 hours later than is considered normal. These individuals may have a stronger circadian evening preference.
  5. Narcolepsy
    • Narcolepsy is a chronic neurological disease that manifests as difficulty with maintaining continuous wake and sleep.
    • Adults with narcolepsy were found to have a twofold greater likelihood of having a childhood diagnosis of ADHD.
    • Children with ADHD experience hypoarousal and that their hyperactive/impulsive symptoms may be compensatory behaviors for fatigue.

Sleep disturbances caused by ADHD have been overlooked for a number of reasons. Sleep disturbances associated with ADHD generally appear later in life, at around age 12, on average. Just as ADHD does not go away at adolescence, it does not go away at night either. It continues to impair life functioning 24 hours a day.

Individuals suffering from ADHD and sleep disorders should practice good sleep hygiene.  There are a few universal rules to follow, as mentioned in previous postings:

  • Use the bed only for sleep or sex
  • Have a set bedtime and a bedtime routine
  • Avoid naps during the day
  • Actually get into bed to start shutting down to start the process
  • Avoid caffeine late in the day
  • Try to limit the usage of electronic devices in bed
  • Do not keep a TV in the bedroom
sleep disorders and technology addiction

References:

Wajszilber D, Santiseban JA, Gruber R. Sleep disorders in patients with ADHD: impact and management challenges. Nat Sci Sleep. 2018;10:453-480. Published 2018 Dec 14. doi:10.2147/NSS.S163074

Corkum P, Tannock R, Moldofsky H. Sleep disturbances in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1998 Jun;37(6):637-46. doi:10.1097/00004583-199806000-00014. PMID: 9628084.

Gruber R. Sleep characteristics of children and adolescents with attention deficit-hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2009 Oct;18(4):863-76. doi: 10.1016/j.chc.2009.04.011. PMID: 19836693.

Gau SS, Kessler RC, Tseng WL, Wu YY, Chiu YN, Yeh CB, Hwu HG. Association between sleep problems and symptoms of attention-deficit/hyperactivity disorder in young adults. Sleep. 2007 Feb;30(2):195-201. doi: 10.1093/sleep/30.2.195. PMID: 17326545.

Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry. 2003 Jun;2(2):104-13. PMID: 16946911; PMCID: PMC1525089.

Weiss MD, Craig SG, Davies G, Schibuk L, Stein M. New research on the complex interaction of sleep and ADHD. Curr Sleep Med Rep. 2015;1(2):114–121. 

Floros O, Axelsson J, Almeida R, Tigerström  L, Lekander M, Sundelin T, Petrovic P. Vulnerability in executive functions to sleep deprivation is predicted by subclinical ADHD symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 17 December 2020. doi: 10.1016/j.bpsc.2020.09.019.